Article Text

Download PDFPDF

Health practitioners’ perceptions of adopting clinical prediction rules in the management of musculoskeletal pain: a qualitative study in Australia
  1. Joan Kelly1,2,
  2. Michele Sterling1,2,
  3. Trudy Rebbeck2,3,
  4. Aila Nica Bandong3,4,
  5. Andrew Leaver3,
  6. Martin Mackey3,
  7. Carrie Ritchie1,2
  1. 1 Recover Injury Research Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
  2. 2 NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Gold Coast, Australia
  3. 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia
  4. 4 College of Allied Medical Professions, University of the Philippines, Manila, Philippines
  1. Correspondence to Joan Kelly; joan.kelly{at}


Objectives To investigate health practitioners’ understanding and practice behaviours with regards to clinical prediction rules (CPRs) and explore their perceptions of adopting a new whiplash CPR.

Design Qualitative study using six semistructured focus groups.

Setting Primary and secondary care in New South Wales and Queensland, Australia.

Participants Physiotherapists (n=19), chiropractors (n=6) and osteopaths (n=3) were purposively sampled to include health practitioners who provide routine treatment to people with whiplash-associated disorders.

Methods Focus group discussions (n=6) were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach.

Results Health practitioners’ understanding and use of CPRs were mixed. Clinicians considered components relating to acceptability (‘whether I agree with it’) and implementation (‘how I'll use it’) when deciding on whether to adopt a new CPR. Acceptability was informed by four themes: knowledge and understanding, CPR type, congruence and weighted value. Consideration of matters that promote implementation occurred once a CPR was deemed to be acceptable. Three themes were identified as potentially enhancing whiplash CPR implementation: the presence of an external driver of adoption, flexibility in how the CPR could be administered and guidance regarding communication of CPR output to patients.

Conclusions Education on CPR purpose and fit with practice is needed to enhance the perceived acceptability of CPRs. Strategies that facilitate practitioner motivation, enable administrative flexibility and assist clinicians in communicating the results of the whiplash CPR could promote adoption of the whiplash CPR.

  • pain management
  • qualitative research
  • rehabilitation medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from


  • Contributors JK contributed to study design, acquisition and interpretation of data and drafted the manuscript. MS, TR, ANB, AL and MM contributed to study design, acquisition of data and revised the manuscript for critically important intellectual content. CR contributed to study design, acquisition and interpretation of data and revised the manuscript for critically important intellectual content. All authors approved the final manuscript and agree to be accountable for all aspects of the work.

  • Funding This work was supported by Motor Accident Insurance Commission Queensland and State Insurance Regulatory Authority New South Wales.

  • Competing interests None declared.

  • Ethics approval University of Sydney and Griffith University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional quotations supportive of the study's key themes are available as online supplementary material. Anonymised transcripts can be provided to interested researchers by contacting the corresponding author.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.